Dry Needling and acupuncture for chronic pain relief

Sufferers of pain are not masochists. Trying to relieve chronic muscular, skin, and joint pain usually can be masochistic. From hot creams to pills with nasty side-effects and to surgeries with marginal success, people with chronic pain go through many pains to relieve the unbelievable. What about needles as in Dry Needling and acupuncture for pain relief? Yikes! More pain? Actually many see it as longer-term relief.

Chronic pain often comes from physical sources. The lingering may also affect emotional, psychic, and energy.

Some say there’s nothing worse than chronic pain. From pharmacies, there are wide varieties of topical and oral analgesics to help sufferers. Doctors also have stronger prescription drugs for fighting inflammation…purportedly one of the triggers of muscular, nerve, and joint pains. Opioids are also prescribed to deaden pain but also nullify most aspects of living. Then there are surgical procedures. These may average only about 75+% accuracy in fixing the problem.

Chronic pain is not new. For thousands of years, Asian cultures have built philosophies that pain is derived from blocked energies. Acupuncture has been one that has survived through to our present era. Acupuncture uses needles placed at energy meridians. Some consider it kinky. Many see it as no alternative. Others swear by therapeutic validity. Many health and wellness centers add acupuncture to their menus of care options. In the West, it is called Dry-Needling.

Based on traditional Chinese medicine, acupuncture seeks to balance one’s energy flow — chi — through pathways known as meridians in the body.

Dry needling employs a Western philosophy of attacking pain trigger points, the bands of tight fascia or muscle commonly known as knots.

Originally, anesthesia was injected through hypodermic needles. Researchers discovered it was the needles, not the medication, that did the work. Eventually, doctors and therapists switched to the very thin acupuncture — or dry — needles.

After needles are inserted, an electrical stimulation unit is connected by alligator clips.

The needles act like probes.The electric current does the magic.

The muscles twitch under the low current, sometimes making the needles appear to bounce. What’s happening is knotted muscle is being released, then the electrical stimulation clenches and unclenches the muscle hundreds of times to work out kinks and provide relief.

The vibrations are similar to using a TENS unit — transcutaneous electrical nerve stimulation — in which the doctor or therapist places sticky pads on the target area.

Pain management is a medical discipline, They use painful steroid injections to combat some pain areas. An epidural steroid injection (ESI) is a minimally invasive procedure that can help relieve neck, arm, back, and leg pain caused by inflamed spinal nerves. ESI may be performed to relieve pain caused by spinal stenosis, spondylolysis, or disc herniation.Under X-ray guidance, a small needle is then advanced into the epidural space. Pressure is the usual sensation felt during this procedure. If pain is felt, more local anesthetic will be used. Epidural injections may last for averages of up to one year. Some found relief for up to 5 years. Research to determine the effectiveness of these treatments in the lumbar spine has shown average success rates between 50 percent and 90 percent. Side effects vary from one person to another.

Radiofrequency ablation (RFA) is a relatively new procedure used to reduce pain under medical pain management. An electrical current produced by a radio wave is used to heat up a small area of nerve tissue, thereby decreasing pain signals from that specific area. RFA has proven to be a safe and effective way to treat some forms of pain. It also is generally well-tolerated, with very few associated complications. There is a slight risk of infection and bleeding at the insertion site. While treatment may be subjectively painful, new techniques are introduced for more accuracy and minimized pain. The healing process can take up to 2-4 weeks. Coolief is a newer version of RFA, claiming more comfort and reduced healing.

Pain management doctors also may prescribe a variety of drugs of different types that may help manage chronic pain.

Acupuncturists are not usually medically trained. They are trained by accupuncture schools. Some have rigorous standards and may take years to complete. The length of training at most schools is about three (3) years for acupuncture and four (4) years for Oriental medicine programs. The study of Oriental medicine includes both acupuncture and Chinese herbal medicine.

For example, Olympc champion Michael Phelps used Cupping, as a technique to prepare hus muscles. According to USA National Institutes of Health, Cupping is a practice used in traditional medicine in several parts of the world, including China and the Middle East. It involves creating suction on the skin using a glass, ceramic, bamboo, or plastic cup. Negative pressure is created in the cup either by applying a flame to the cup to remove oxygen before placing it on the skin or by attaching a suction device to the cup after it is placed on the skin. In “wet cupping,” the skin is pierced, and blood flows into the cup. “Dry cupping” doesn’t involve piercing the skin. Used as a mode of therapy by trained acupuncturists, there is little western scientific evidence to support claims.

There is no scientific proof that the meridians or acupuncture points exist, and it is hard to prove that they either do or do not, but numerous studies suggest that acupuncture works for some conditions. Some experts have used neuroscience to explain acupuncture and associations with neurotransmitters and brain processes. There is also little scientific evidence to support or deny.

Pharmacies devote aisles of analgesics to help reduce chronic pain. Few of these have long-lasting effect and many have uncomfortable side effects…replacing one pain with another,

Statistics show that 1 out of 5 people may sometime develop chronic pain. Generally, when drug companies aim to help solve the problem, they target the pain in several ways.

Pfizer-Lily is one of the leading sources of these drugs. They indicate that when injury or inflammation occurs, a number of biochemical mediators, including prostaglandins, cytokines, chemokines, neuropeptides, and nerve growth factor (NGF), are released. In conditions related to chronic musculoskeletal pain, such as osteoarthritis (OA), rheumatoid arthritis (RA), tendinitis, and chronic low back pain (CLBP), these mediators have been identified as key drivers of chronic pain.

Disease can also be the underlying cause of chronic pain. Rheumatoid arthritis, osteoarthritis and fibromyalgia are well-known culprits, but persistent pain may also be due to such ailments as cancer, multiple sclerosis, stomach ulcers, AIDS, and gallbladder disease. Rheumatoid arthritis, osteoarthritis, neuralgia, and fibromyalgia are well-known culprits that trigger pain and are usually co-antagonists partnering the issue. Neuralgia is a sharp, shocking pain that follows the path of a nerve and is due to irritation or damage to the nerve. These nerves are found along the skeleton and impact muscles and joints in many ways.

Radiology has discovered several of the areas that may be catalysts and sources bring the pain. As nothing is 100%, the medical community seeks the least invasive methods to treat chronic pain. They use chiropractics and technologies to help reduce pain. Often something like fibromyalgia are more daunting as challenges. Fibromyalgia may be associated with hundreds of different source areas. And these are studied but it’s a slow process.

Chronic pain is not new. Acupuncture and dry needles were among the earliest attempts to cope or eliminate pain. Acupuncture was first mentioned and recorded in documents dating a few hundred years before the Common Era. Earlier instead of needles sharpened stones and long sharp bones were used around 6000 BCE for acupuncture treatment. Before stones, there may have been hands applying pressure (massage). Acupressure is a type of acupuncture. Both acupressure and acupuncture are based on same fundamental principle of acupoint activation across the meridians So chronic pain treatment may go back over 8000 years.

Today about 20% of people suffer from chronic pain. That’s more people than with diabetes or cardiovascular diseases.

Chronic pain differs from masochism as the pain is totally involuntary. A masochist is a person who is gratified by pain, degradation, etc., that is self-imposed or imposed by others…as an alternate lifestyle, according to the Diagnostic Statistic Manual (DSM). Chronic pain sufferers are most likely NOT masochists.

That does not debunk that chronic pain may not be mind induced. A pain disorder is chronic pain experienced by a patient in one or more areas, and is thought to be caused by psychological stress. The pain is often so severe that it disables the patient from proper functioning. Duration may be as short as a few days or as long as many years. Psychogenic pain is also known as psychological pain or depression. While psychogenic pain is primarily psychological, it is a very real type of chronic pain. … With psychogenic pain, however, there is often no physical cause to find and treat.

Chronic pain is a health condition that many still admit is shrouded by inconclusive sources. The belief that having sterile needles inserted, or electric nerve impulses probed are among many ways people seek to end chronic pain. Alas, there’s no conclusive answer. There are possible methods and acupuncture is among the oldest. Physical or psychological sourced, seeking help is often filled with risks that may be worse than the pain you are already experiencing.

Solutions are anti-masochistic attempts to be pain-free. Only one such solution may eliminate chronic pain. Some seek it. Since 1999, suicide rates have steadily increased, and suicide is now the 10th leading cause of death in the United States. The prevalence of chronic or severe pain has also risen, and researchers believe it could be contributing to the rise in suicide rates. It caught the attention of the CDC or Centers of Disease Control.

During the study period, the CDC identified 123,181 individuals who died by suicide, including 10,789 who experienced chronic pain. From 2003 to 2014, the percentage of suicides with chronic pain rose from 7.4 percent to 10.2 percent. Not a wide variance range so more studies are needed to see how prevalent chronic pain is to suicide rates.

Chronic pain sufferers, as long as there remain remedies for chronic pain. seek them out. It is yet another important reason why national health insurance is necessary. Research suggests that anywhere from 30 to 50% of people with chronic pain also struggle with depression or anxiety. Because chronic pain can affect an employee’s work performance and job satisfaction, it’s important that chronic pain is addressed and accommodated at a company. In 2012, NCBI through PubMed, posted a study conclusion: The body of evidence identified from the systematic review indicates that CP has a substantial negative impact on work-related outcomes, supporting the importance of interventions to reduce the burden of CP. Well-designed prospective studies specifically assessing the direct consequences of CP on employment are needed to confirm these findings.

While research is sparse, CP or Chronic Pain is an issue that USA needs to address. In an era where Post Traumatic Stress Disorder (PTSD) is prevalent beyond veterans. A 2013 study found that illness-focused pain coping mediated the relationship between post traumatic stress disorder and both pain interference and pain severity.

Chronic pains are issues that need to be thoroughly examined. Sometimes untraditional traditions need to be included in research.

Concerta concert for ADHD

Somewhere in the recent 20th century, the medical community begat ADHD (attention deficit hyperactivity disorder) as an umbrella term for school age children with certain behavioral conditions. ADHD was first coined in 1902. ADHD became popular when APA recognize ADHD in the late 1960’s in the 1968 Diagnostic Statistics Manual. By the 1980’s, ADHD was a popular psychiatric condition for children who misbehaved.

ADHD is a chronic condition marked by persistent inattention, hyperactivity, and sometimes impulsive behaviors. ADHD begins in childhood and often lasts into adulthood. As many as 2 out of every 3 children with ADHD continue to have symptoms as adults.

According to the Centers of Disease Control (CDC), Millions of US children have been diagnosed with ADHD. The estimated number of children ever diagnosed with ADHD, according to a national 2016 parent survey, is 6.1 million.. This number includes: 388,000 children aged 2–5 years. 4 million children aged 6–11 years.Statistics, however, toll 4.4% of adults in the USA may have the ADHD diagnosis. Is it under-diagnosed among adults?

There are many chronic conditions. Some are genetic such as muscular dystrophy, multiple sclerosis, and Palsy. Neuralgia and arthritis may be developmental. Perhaps the biggest US pain (besides politics) is back pain. Compressed and or herniated spine discs are diagnosed as stenosis. Approximately, according to Medscape,250,000-500,000 US residents have symptoms of spinal stenosis. This represents about 1 per 1000 persons older than 65 years and about 5 of every 1000 persons older than 50 years. About 70 million Americans are older than 50 years, and this number is estimated to grow by 18 million in the next decade alone, suggesting that the prevalence of spinal stenosis will increase. Few have 100% treatments for pain relief of these.

ADHD seems to shift greatly when it comes to kids and adults under this umbrella. The term chronic, as through lifespan, brings great market potential for drugs and accessories to commonly treat ADHD sufferers. From ages 3 to 12, most of those sufferers are reported by parents. Concerta and Adderall are commonly prescribed drugs for those that fall beneath the ADHD umbrella.

There are a few prescription drugs used for treating some symptoms of ADHD. One of the first was Ritalin. In the 1980’s, if you’re child wasn’t taking Ritalin (a stimulant), it was considered odd. Ritalin was later replaced by Adderall and Concerta. Concerta was first to promote an Extended Release version that helped minimize side effects. The generic name of Concerta ER is methylphenidate extended-release tablets.

Current prescription drugs are designed for children and adults with ADD. Adderall contains amphetamine-like chemicals that stimulate the brain and central nervous system, producing a calming effect in adults and children with ADHD. Concerta is a stimulant that acts in a similar manner, but the effect is milder than that of amphetamines. Concerta is more common than Adderall.

According to Drugs.com, medical advice is urged. The “Do not use” information is vast:

Do not use Concerta if you have used an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, tranylcypromine, and others, as well as methylene blue injection.

You should not use Concerta if you are allergic to methylphenidate, or if you have:

glaucoma

a personal or family history of tics (muscle twitches) or Tourette’s syndrome; or

severe anxiety, tension, or agitation (stimulant medicine can make these symptoms worse).

Stimulants have caused stroke, heart attack, and sudden death in certain people. Tell your doctor if you have:

heart problems or a congenital heart defect;

high blood pressure; or

a family history of heart disease or sudden death.

To make sure Concerta is safe for you, tell your doctor if you or anyone in your family has ever had:

depression, mental illness, bipolar disorder, psychosis, or suicidal thoughts or actions;

motor tics (muscle twitches) or Tourette’s syndrome;

blood circulation problems in the hands or feet;

seizures or epilepsy;

problems with the esophagus, stomach, or intestines;

an abnormal brain wave test (EEG); or

a history of drug or alcohol addiction.

It is not known whether Concerta will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant. It is unknown whether the active drug enters breast milk.

Suppose you pass precautionary tests, what might side effects be?

Check with your doctor immediately if any of the following side effects occur while taking methylphenidate (the generic chemical found in Adderall and Concerta):

More common
Fast heartbeat

Less common
Chest pain
fever
joint pain
skin rash or hives

Rare
Black, tarry stools
blood in the urine or stools
blurred vision or other changes in vision
crusting, dryness, or flaking of the skin
muscle cramps
pinpoint red spots on the skin
scaling, severe redness, soreness, or swelling of the skin
seizures
uncontrolled vocal outbursts or tics (uncontrolled and repeated body movements)
unusual bleeding or bruising

Incidence not known
Confusion
depression
feeling like surroundings are not real
numbness of the hands
painful or difficult urination
pale skin
paleness or cold feeling in the fingertips and toes
red, irritated eyes
red, swollen, or scaly skin
seeing, hearing, or feeling things that are not there
severe or sudden headache
sores, ulcers, or white spots on the lips or in the mouth
sudden loss of coordination
sudden slurring of speech
tingling or pain in the fingers or toes when exposed to cold
unusual behavior
unusual tiredness or weakness
weight loss
yellow skin or eyes
Get emergency help immediately if any of the following symptoms of overdose occur while taking methylphenidate:

Symptoms of overdose may include:
Agitation
anxiety
bigger, dilated, or enlarged pupils of the eyes
confusion as to time, place, or person
dark-colored urine
diarrhea
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
dry eyes, mouth, nose, or throat
false or unusual sense of well-being
fast, slow, irregular, pounding, or racing heartbeat or pulse
holding false beliefs that cannot be changed by fact
increased sensitivity of the eyes to light
loss of consciousness
muscle pain or stiffness
muscle twitching
nervousness
overactive reflexes
pounding in the ears
rapid, shallow breathing
sweating
tremors
unusual excitement, nervousness, or restlessness

WOW! All these possible life threatening possibilities you might encounter as you try to resolve ADHD!

If ADHD is a disease at all, it is likely associated with several. Neuralgia and Rheumatoid Arthritis may be associated with 100’s of unknown but possible conditions. Is ADHD an actual disease or is it a trumped up classification?

Physicians who migt read labels are cautioned: CNS stimulants, including methylphenidate extended-release orally disintegrating tablets, other methylphenidate-containing products, and amphetamines, have a high potential for abuse and dependence. Assess the risk of abuse prior to prescribing, and monitor for signs of abuse and dependence while on therapy. Yes, these meds do help ADHD patients feel more normal but addiction is high.

ADDitude Journal is a great repository of ADHD information. Some small studies show that ADHD brains have low levels of a neurotransmitter called norepinephrine. Norepinephrine is linked arm-in-arm with dopamine. Dopamine is the thing that helps control the brain’s reward and pleasure center. The ADHD brain has impaired activity in four functional regions of the brain.

Some neuroscientists ask why has ADHD developed to such great proportions? Today’s ready access to electronic digital devices and the internet often substitute for social interaction. Such situation, if it starts in early childhood, in certain vulnerable individuals, who crave immediate rewards, can decrease the ability to maintain prolonged attention and tolerate delayed gratification, thus reinforcing future addictive behaviors. Essentially, many parents don’t realize that all those Smart devices that is “their world” also modifies how their brains process reality. Rewards and punishments are more pertinent from social media than traditional studying.

Assessing ADHD is generally subjective. Currently, clinical interviews and collateral histories from parents and teachers drive the standards. Only occasionally do we use objective assessments, such as continuous performance tasks and neuropsychological assessments, to evaluate whether or not a child can sustain attention, and whether their deficits lie in either or both auditory and visual domains. Other factors may be involved, such as motivation, low blood glucose, lack of sleep, or medication they are taking.

Thus, in the neuroscience perspective, actual ADHD diagnoses may actually be blown up to 5-times of those patients diagnosed with ADHD. Yet most Primary Care doctors hear the symptoms and prescribe Concerta ER.

As many world ADHD studies are relatively small, more work will need to establish whether Concerta ER is best for treatment. The manufacturers will hotly debate any results.

While diagnoses of ADHD may be more or less accurate, available evidence suggests that ADHD is genetic — passed down from parent to child. It seems to “run in families” — at least in some families. At least one-third of all fathers who had ADHD in their youth have children with the condition. The majority of identical twins share the ADHD trait.

All this aside, ADHD adults are smart, articulate, and hold responsible jobs. Perhaps ADHD-Adult may be more of a mix than most doctors realize. Yet…doctors are the professionals patients interface with. Problems could be elsewhere.

I believe ADHD has become more of an umbrella term among doctors and parents, regarding the behavior of their children. Personalities differ as do cultural and parental interaction. Most important, this is a digital age and kids can access and use devices more efficiently than parents. ADHD may be a reality today. Kids are kids. How they behave unlocks new doors from 1 gen to the next. Who knows how these kids develop and whether ADHD will be the problem it is today. Who knows if the Concerta concert will be valid.

What brainwaves have to do with it?

What’s your frequency? Brain theorists believe that certain health conditions may be caused and effected by the 4 or 5 frequencies your brain functions at. What do brain waves have to do with it?

The human brain is made up of brain cells called neurons, which communicate with each other through electrical brain waves. The pattern of brain waves changes depending on one’s level of consciousness and cognitive processing. For example, when one feels fatigued or dreamy, slower brainwaves are likely dominant at that time.

Feeling stressed out? Brain waves may be one of the underlying causes. Some studies indicate that cyclical speeds our brain waves may contribute to ADHD and Hypertension.

Brainwaves are produced by synchronized electrical pulses from masses of neurons communicating with each other. Brainwaves are detected using sensors placed on the scalp. Brainwave speed is measured in Hertz (cycles per second) and they are divided into bands delineating slow, moderate, and fast waves.

There are 5 types of brain waves your brain generates:

Gamma waves >40 Hz –
Higher mental activity, including perception, problem solving, and consciousness

Beta waves – 13–39 Hz
Active, busy thinking, active processing , active concentration, arousal, and cognition

Alpha waves – 7–13 Hz
Calm relaxed yet alert state

Theta waves – 4-7 Hz Deep meditation /relaxation, REM sleep. REM sleep is an exception, with recorded speeds of 30 to 50 Hz, During REM, you experience dream episodes. In addition, neurotransmitters work at forming long-term memory storage.

Delta waves – < 4 Hz Deep dreamless sleep, loss of body awareness Gamma and Beta are associated with wakefulness Alpha, Theta, Delta are associated with relaxation. Awakening from Delta or during a REM is indicative of deep, meditative sleep. They are generated in deepest meditation and dreamless sleep. According to Scientific American, Delta waves typically center around a range of 1.5 to 4 cycles per second. They never go down to zero because that would mean that you were brain dead. But, deep dreamless sleep would take you down to the lowest frequency. Being jolted awake at Delta often results in confusion. During Alpha and Theta, your brain and body are flushed with neurotransmitters that deal with memory and reduced inflammation. A recent 2013 study found that the ADHD brain tends to produce more Theta waves than the brains of average folks. Theta waves are the ones you produce as you’re nodding off to sleep. Or watching a boring TV show or movie. They indicate a state of deep relaxation.

For the study, teens between the ages of 12 and 17 were asked to perform computer tasks that involved perceiving a visual stimulus that would then trigger brain regions involved in decision-making, which then led to physical action — in this case, pressing a button.

Researchers found that the 17 participants that were predominantly diagnosed with the inattentive (IA) subtype of ADHD had the least amount of alpha wave suppression — necessary to filter out visual “noise” in order to make an accurate decision.

In 2014 deviations in brainwaves were said to detect presence/severity of Alzheimer’s Disease.

According to the American Nutrition Association, the reason why brain waves are important is because the delta/beta cycle causes an elevation in blood sugar levels and blood pressure throughout the day.

Beta waves in the high frequencies can cause agitation and anxiety perhaps caused by too much dopamine release. Dopamine problems are implicated in ADHD, Alzheimer’s, Parkinson’s, depression, bipolar disorders, binge eating, addiction, gambling, and schizophrenia.

Anxiety and panic attacks are associated with decreased alpha waves, increased high beta waves, and can be affected by low delta and theta waves. There is a delicate balance of the chemicals called neurotransmitters required within the body for best emotional and physiological health.

Previous studies showed that people with chronic pain experience abnormal neural oscillations, or brain waves. There are several kinds of brain waves related to different brain regions and various kinds of brain activities. People with chronic pain, it is believed, often may have brainwaves to blame. Stress puts you at Beta waves, putting you on alert. You’re waiting to respond. But, as in the classic movie Forbidden Planet, those monsters can not be fought off. It becomes fight, flight, or die. Over time, the brain and central nervous system learn to continue to put the body into a painful state, which repeats the pain cycle. In a sense, staying in Beta might be associated with chronic pain, with no other explanation. Unfortunately, few studies have been large enough for results to have wide acceptance.

One study at University at North Carolina in 2018 demonstrated promising results that stimulating brains helped reduce lower back pain. While chronic lower back pain has many sufferers, this study had only 30 people. Those aren’t enough to persuade a medical community away from codeine painkillers and surgeries. Yet, this study is one of many small studies showing how brainwaves and chronic pain may be related.

As such, many areas have devised treatment centers and recommendations to help induce alpha waves when beta is out of control.

In an article, published in Medical News Today, there are discussions as to how using EEG bio-feedback helps change brainwave patterns to treat conditions that are now only treated by drugs:

EEG biofeedback may help patients with attention deficit hyperactivity disorder (ADHD), addiction, anxiety, seizures, depression, and other types of brain condition.

During a biofeedback session, the therapist attaches electrodes to the patient’s skin, and these send information to a monitoring box.

The therapist views the measurements on the monitor, and, through trial and error, identifies a range of mental activities and relaxation techniques that can help regulate the patient’s bodily processes.

Lacking large empirical studies, biofeedback therapy may not be covered as acceptable treatments by some health insurances. It may require 20 sessions at about $100+ per session.

The goal of biofeedback is often to make subtle changes to the body that result in a desired effect. The Association for Applied Psychophysiology and Biofeedback (AAPB) defines biofeedback as a process that allows people to alter their physiological activity in order to improve health or performance. The American Medical Association defines biofeedback as an alternative therapy. The AAPB is the key organization supporting biofeedback as brainwave therapy.

The study of brainwaves has been observed since 1930, when the EEG was developed. Biofeedback has been applied to studies of sensory deprivation, bi-polar issues, and sleep studies. The questionably issues of brainwaves biofeedback within the USA, as opposed to Europe is that applied science is not viewed as valid as medical science.

The Food and Drug Administration (FDA) has approved a biofeedback device, Resperate, for reducing stress and lowering blood pressure. Resperate is a portable electronic device that promotes slow, deep breathing. However, the FDA doesn’t regulate many biofeedback devices marketed for home use. So…the FDA allows home use of a biofeedback product that, used correctly, may help reduce brainwaves for reducing blood pressure and stress.

I’d recommend using AAPB as a method of finding resources and clinicians for biofeedback. Overall, the integrity of brainwaves has helped people survive over millennia. Reckless use of this method as a cure for many diseases may have other problems emerge. I would like to see further study of brainwaves in large empirical studies to call it a medical utopia.

But many have tried biofeedback and brainwaves therapy. High positive subjective reviews. So if you have chronic hypertension, pain, ADHD, anxiety, and sleeplessness….might be worth a try.